Publication

Progressive computed tomography (CT) appearances preceding malignant spinal cord compression (MSCC) in men with castration-resistant prostate cancer

Journal Paper/Review - Dec 30, 2014

Units
PubMed
Doi

Citation
Pezaro C, Sohaib A, de Bono J, Dearnaley D, Parker C, Lorente D, Bianchini D, Attard G, Mukherji D, Perez-Lopez R, Omlin A, Tunariu N. Progressive computed tomography (CT) appearances preceding malignant spinal cord compression (MSCC) in men with castration-resistant prostate cancer. Clin Radiol 2014
Type
Journal Paper/Review (English)
Journal
Clin Radiol 2014
Publication Date
Dec 30, 2014
Issn Electronic
1365-229X
Brief description/objective

AIM
To test the hypothesis that computed tomography (CT)-based signs might precede symptomatic malignant spinal cord compression (MSCC) in men with metastatic castration-resistant prostate cancer (mCRPC).

MATERIALS AND METHODS
A database was used to identify suitable mCRPC patients. Staging CT images were retrospectively reviewed for signs preceding MSCC. Signs of malignant paravertebral fat infiltration and epidural soft-tissue disease were defined and assessed on serial CT in 34 patients with MSCC and 58 control patients. The presence and evolution of the features were summarized using descriptive statistics.

RESULTS
In MSCC patients, CT performed a median of 28 days prior to the diagnostic magnetic resonance imaging (MRI) demonstrated significant epidural soft tissue in 28 (80%) patients. The median time to MSCC from a combination of overt malignant paravertebral and epidural disease was 2.7 (0-14.6) months. Conversely, these signs were uncommon in the control cohort.

CONCLUSIONS
Significant malignant paravertebral and/or epidural disease at CT precede MSCC in up to 80% of mCRPC patients and should prompt closer patient follow-up and consideration of early MRI evaluation. These CT-based features require further prospective validation.